COVID-19 封锁对肝切除术后发病率的影响：基于全国性法国数据库的倾向评分匹配研究。
Impact of COVID-19 lockdowns on postoperative morbidity after hepatectomy: A propensity-score matching study on a national French database.
机构信息
Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique - Hôpitaux de Paris Centre and University of Paris, France.
Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique - Hôpitaux de Paris Centre and University of Paris, France.
出版信息
Surgery. 2023 Aug;174(2):196-202. doi: 10.1016/j.surg.2023.03.008. Epub 2023 Apr 11.
BACKGROUND
The impact of the SARS-CoV-2 pandemic on managing liver malignancies worldwide is unknown. This study aimed to determine the impact of lockdowns on patient clinical pathways and postoperative morbi-mortality.
METHODS
This study evaluated all adults' hospital stays for liver tumors between 2019 and 2021 from the national French discharge database. The primary outcome was the clinical pathway, especially surgical care and postoperative outcomes, between patients admitted during COVID-19 lockdown periods (lockdown group) and during the same periods of 2019 and 2021 (control groups).
RESULTS
The overall population included 58,508 patients: 18,907 patients in the lockdown group, 20,045 in the 2019 control group, and 19,556 in the 2021 control group. Surgical activity decreased by 11.6% during lockdowns, with 1,514 (8.0%) of patients in the lockdown group treated by surgery, 1,514 (8.6%) in the 2019 control group (P < .001), and 1,466 (7.4%) in the 2021 control group. Chemotherapy was considered more during the lockdowns (P < .001). More patients were operated in small-volume centers during the lockdowns (34% vs 32% vs 32%, P = .034), and fewer were hospitalized in highly populated regions (P < .001). Postoperative morbidity (47% vs 47% vs 47%, P = .90) and mortality (3.3% vs 3.6% vs 3.1%, P = .80) were comparable in the 3 periods, with no influence of lockdowns on morbidity (risk ratio = 0.94, 95% confidence interval = 0.81-1.09, P = .40) or mortality (odds ratio = 1.12, 95% confidence interval = 0.72-1.74, P = .6). Postoperative pulmonary (17% vs 13%, P = .024) and septic complications (20% vs 15%, P = .022) were significantly higher during the first lockdown compared to the second.
CONCLUSION
This study provides a French overview of liver malignancy management during the COVID-19 pandemic. Moreover, surgical activity decreased by 11.6% in high-volume centers, with no impact on postoperative morbidity and mortality.
背景
SARS-CoV-2 大流行对全球肝脏恶性肿瘤管理的影响尚不清楚。本研究旨在确定封锁对患者临床路径和术后病死率的影响。
方法
本研究评估了 2019 年至 2021 年期间全国法国出院数据库中所有成年人因肝脏肿瘤住院的情况。主要结局是 COVID-19 封锁期间（封锁组）和 2019 年和 2021 年同期（对照组）入院患者的临床路径，特别是手术护理和术后结果。
结果
总体人群包括 58508 例患者：封锁组 18907 例，2019 年对照组 20045 例，2021 年对照组 19556 例。封锁期间手术活动减少了 11.6%，有 1514 例（8.0%）封锁组患者接受手术治疗，2019 年对照组 1514 例（8.6%）（P<.001），2021 年对照组 1466 例（7.4%）。封锁期间考虑了更多的化疗（P<.001）。封锁期间更多的患者在小容量中心接受手术（34%对 32%对 32%，P=0.034），在人口较多的地区住院的患者减少（P<.001）。3 个时期的术后发病率（47%对 47%对 47%，P=0.90）和死亡率（3.3%对 3.6%对 3.1%，P=0.80）相当，封锁对发病率（风险比=0.94，95%置信区间=0.81-1.09，P=0.40）或死亡率（比值比=1.12，95%置信区间=0.72-1.74，P=0.60）无影响。与第二次相比，第一次封锁期间肺部（17%对 13%，P=0.024）和脓毒症并发症（20%对 15%，P=0.022）显著更高。
结论
本研究提供了 COVID-19 大流行期间法国肝脏恶性肿瘤管理的概述。此外，高容量中心的手术活动减少了 11.6%，但术后发病率和死亡率没有影响。
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